Abstract

The U.S. healthcare system has a history of continuous organizational change. The result is by no means a perfect healthcare system. A byproduct of this history is a large number of experiments, making the U.S. probably the largest laboratory for healthcare delivery reform in the world. Both quality and costs are pressing issues for U.S. healthcare reform. Efforts to address these issues by means of integrated care delivery and innovative payment models are mostly driven by the Centers for Medicare and Medicaid Services (CMS). Many of CMS’s reform efforts can be linked to goals that are known as the Triple Aim: improving the experience of care and the health of populations while reducing per-capita costs. These aims conflict with traditional, fragmented delivery structures and fee-for-service (FFS) payments, which are still the norm for reimbursing providers. One of the most discussed alternative payment models is the accountable care organization (ACO). This chapter illustrates the concept of ACOs and discusses some preliminary findings on the impact of this mode of integrated care delivery.